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When is it time for a new office?

April 1, 2009
Your first response to this question may be, “not now!” Your second response might be unintelligible muttering about the stock market ...

by Jeff Carter, DDS, Pat Carter, IIDA, and Dave Fazio, AIA

For more on this topic, go to and search using the following key words: office design, Dr. Jeff Carter, Pat Carter, Dave Fazio, motivators, decisions.

Your first response to this question may be, “not now!” Your second response might be unintelligible muttering about the stock market, hedge funds, ponzi scheme investments, lending institutions' instability, etc. Until finally you decide the smart thing to do is nothing. Well, perhaps surprisingly, that may not be the smartest thing.

As baby boomers, our parents often espoused the best investments you could ever make were in yourself and your business. For many of us, we were taught the importance of education, the ethics of applying ourselves through hard work, the value of persistence in the face of adversity, and the rewards of professional integrity. Interestingly, the information technology transformation supplanted this tenet.

Many assumed business success was achieved through seemingly instantaneous financial transactions involving global markets and esoteric data. We have all witnessed the potential fallacy of these assumptions. In times of uncertainty, a return to investing in your own practice is not only justified, it is advisable. Your practice is an active investment you impact personally. And while lending parameters are fluid, lenders are keenly focused on low-risk opportunities, and dental practitioners remain viable lending candidates. This is a key asset you as a dental professional can overlook when assuming it “isn't a good time.”

The appropriate question to answer: Is it time for you to do a new office?

Building a new facility — lease space or full building — is one of the biggest investments in your practice career and warrants thoughtful consideration. The first step is making the decision to proceed and that requires a compelling reason or reasons to do so. Beginning a new office project because it seems like a good thing to do or you hope it will help you love dentistry again may not be enough to sustain you through the course of your project. Through the years, the dental office projects that lay stagnant and never progressed past the pronounced “I'm going to do a new office” were those of dentists without enough good reason to compel them through the challenges inherent in any building project or to step beyond their fear in doing so.

Compelling reasons will prompt you to action. They remind you that each step taken is the right thing to do. And what may be an urgent reason for doing a new office to one practitioner may be a minor consideration to another. Following are the top compelling reasons to do a new office. These come from our own observations and from the dentist clients who over the years have shared with us that which drove them throughout the process:

Situational motivators

  • You are a seasoned practitioner and have a lease that is expiring with no option of renewal. No matter the reason, being forced out of your location will propel you into a dental office project. And while not an enviable position, it is not an uncommon compelling reason.
  • You are an associate. And whether a “practice ownership buy in” soured or being an associate was mentor driven, you are now ready to set up your own practice.
  • You are a recent graduate and prefer to start your own practice rather than transition through another.

Situational circumstances alone can be compelling enough to move you into a new office decision. More often, it is accompanied by other reasons — those we refer to as practice driven.

Practice-driven motivators

  • You cannot keep up with patient demand. Your perception is that patients are being turned away or are disappointed with the difficulty in getting an appointment. Even if you are “making it work,” you and your staff are stressed with the pressure of trying or failing to keep up.
  • Your practice facility is “tired” and “dated.” You have anxiety about losing existing patients to newer, more “high-tech” offices in your area.
  • You aren't attracting new patients into the practice. It may be that your new patient count has plateaued or begun to decrease or your efforts to “market” don't seem to be making an appreciable difference.
  • You aren't retaining or attracting quality staff. You sense your tired, outdated office is hindering your ability to secure or keep the top people in your area. Instinctively, you know quality staff seek employment in quality environments.
  • Your equipment is outdated. While your facility may function satisfactorily, your patients see older worn equipment, ripped upholstery, and a lack of successful high-tech integration with cables everywhere as indicative of an outdated and disorganized dentist.
  • You are within 10 years of retirement and have anxiety about whether your existing facility will attract a younger transitional partner or buyer.
  • You enjoy the practice of dentistry, but dread going into the office. It is common for us to hear from dentists that their current office is greatly diminishing their enjoyment of dentistry. Whether functionally challenging, esthetically dismal, or both, the condition of your current office may be enough to motivate you into a new office.
  • You are embarrassed by your facility. While your peers are proudly posting pictures of their offices on Web sites, you know your facility neither deserves posting nor reflects the quality of care you provide. The disparity fosters anxiety and stress between you, your staff, and your patients.
  • Your facility is located in an area that is “no growth” or deteriorating. Once a booming area of town, your locale has begun to deteriorate and is affecting your ability to attract new patients and grow the practice. Remaining can be a cost to the practice that propels you into a new office where your practice can flourish.
  • Your facility is satisfactory, but the infrastructure has become costly. It can be the rising cost of heating and cooling an older building, a rental rate that jumps exponentially, frustration over leaking roofs and disrepair on the part of an insensitive landlord, or having patients freezing in the waiting area while you sweat in the operatories. Whatever the cost for staying, it is no longer worth the frustration and “coping.”
  • Your facility has few or no windows in treatment areas. It seemed less important when you first started your practice because you were focused on dentistry, attracting new patients, and learning how to run the business. And then one day you realized that when you left at the end of the day, you never saw the day. And that just wasn't worth it anymore.
  • You've minimized the support and the productive areas (operatories) of your office to meet patient demand. Conversion of low priority areas into treatment areas has created bottlenecks at the front, a pressing lack of storage, the loss of private space (your office or staff area), and minimal clinical support areas, which have now created stress and inefficiencies. The conclusion: I need a new office.

Making the decision to do a new office is the biggest step

The circumstances of your current office that don't work, that cost you more than they are worth, that are keeping you from advancing, that create stress, frustration, and angst will be the reasons that compel you.

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Dentists complaining about the loss of function or esthetics or both and their inability to improve it (even after multiple remodels) reach that moment when they recognize their offices are holding them back.

And once you have reached that point, the decision becomes an easy one. It becomes the impetus that starts the planning, design, and construction process that will positively change your professional experience and career in substantial ways. We know this, because we have seen it time and time again.

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Increased patient flow, unsolicited great staff resumes on your desk, higher production with less stress, and a facility that reflects the dentistry you do can be your reward. If the reasons compel you, it is the right time to do a new dental office.

And if so, you may ask ... now what? We'll tackle that next month.

Jeff Carter, DDS, Pat Carter, IIDA, and Dave Fazio, AIA, are owners of PDGFazio Design Group. Located in Austin, Texas, PDGFazio offers a full range of architectural, interior design, and consulting services to dentists nationwide. For more information, call (800) 511-7110 or visit

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